# 護理師檢視一名因強直陣攣性癲癇服用 phenytoin 的病人，血清濃度為 24 mcg/mL。護理師預期會評估到哪些臨床表現？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

護理師檢視一名因強直陣攣性癲癇服用 phenytoin 的病人，血清濃度為 24 mcg/mL。護理師預期會評估到哪些臨床表現？

## 選項

1. 眼球震顫、共濟失調、言語不清與混亂 **✔ 正確答案**
2. 高血壓、心搏過慢與針尖樣瞳孔
3. 唾液分泌增加與支氣管痙攣
4. 深部肌腱反射亢進與陣攣

**正確答案: 1**

## 解析

正解 (1): 治療範圍為 10-20 mcg/mL。超過20時，眼球震顫是最早徵象，之後可出現共濟失調、言語不清與混亂。超過30-40時可能嗜睡或昏迷。(2) 較像鴉片類毒性。(3) 較像血清素症候群或甲狀腺亢進。(4) 是膽鹼激性危象表現。

## 深入解析

記憶提示 phenytoin 毒性階梯：20+ 眼球震顫 → 30+ 共濟失調 → 40+ 嗜睡/昏迷。低白蛋白血症時需校正濃度再解讀。

## 臨床情境

情境 45歲男性，已服用phenytoin 300 mg PO daily 6週。今日谷濃度為24 mcg/mL（治療範圍10-20）。他表示房間感覺在搖晃。

## 重要概念

- **治療範圍** — 在療效與毒性間取得平衡的血中藥物濃度；phenytoin 為10-20 mcg/mL。
- **眼球震顫** — 非自主且有節律的眼球運動；phenytoin 毒性最早的臨床徵象。
- **狹窄治療指數** — 治療劑量與毒性劑量之間差距很小；phenytoin 需要定期監測血中濃度。

## 相同主題題目

- [A nurse is caring for an alert adult client with type 1 diabetes who reports tremors, swea…](https://mymerci.kr/pages/nclex_q.php?qn_id=360524&lang=zh-tw)
- [A 68-year-old client with COPD is admitted with shortness of breath and SpO2 86% on room a…](https://mymerci.kr/pages/nclex_q.php?qn_id=362940&lang=zh-tw)
- [A 58-year-old client arrives at the emergency department with crushing substernal chest pa…](https://mymerci.kr/pages/nclex_q.php?qn_id=362976&lang=zh-tw)
- [A 72-year-old client is brought to the emergency department by family who report that the …](https://mymerci.kr/pages/nclex_q.php?qn_id=363003&lang=zh-tw)
- [A 79-year-old client is admitted from a long-term care facility with diarrhea, decreased o…](https://mymerci.kr/pages/nclex_q.php?qn_id=363089&lang=zh-tw)
- [A 76-year-old female with chronic heart failure and atrial fibrillation receives digoxin 0…](https://mymerci.kr/pages/nclex_q.php?qn_id=374883&lang=zh-tw)
- [A 70-year-old client on long-term digoxin therapy reports new yellow-green halos around li…](https://mymerci.kr/pages/nclex_q.php?qn_id=374884&lang=zh-tw)
- [A 58-year-old client with type 2 diabetes mellitus and migraine prophylaxis is taking prop…](https://mymerci.kr/pages/nclex_q.php?qn_id=374893&lang=zh-tw)

## 以其他語言閱讀

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=391737&lang=vi)

---

More free questions: [NCLEX-RN 題庫](https://mymerci.kr/pages/nclex_bank.php?lang=zh-tw)

_僅供學習參考。實際臨床請遵循最新指引與所屬機構規範。_